Time will define Juvederm's place among HA fillers

Juvederm, which has long been available in Europe, received Food and Drug Administration (FDA) approval last June for facial wrinkles and folds and is expected to make its widespread debut on the U.S. market this year.

"Only a good head-to-head study, however, will determine if one lasts longer than the other, and that hasn't been conducted yet," Dr. Narins says.

"I find it easy to inject both Juvederm and Restylane, and I know they both last between six to 12 months, with at least some of both products probably still in place at nine months," she says.

Dr. Narins is among a number of dermatologists who received Juvederm to use on a trial basis, and she says she has so far had good results.

"I've found it to be a very good HA filler," she says.

"It's very good for the lips and is indeed very smooth. I think ultimately it will help to increase the total filler market in the U.S."

Combinations

Juvederm also will probably offer optimal results when paired with Botox, Dr. Narins notes.

"Botox is best for the upper face and fillers are best for the lower face, so the combination of Juvederm and Botox will likely give the best nonsurgical rejuvenation."

Other potential combinations could include Juvederm or Restylane in the lips, combined with Radiesse (BioForm Medical) in the nasolabial folds, or Juvederm with lasers such as IPL to help reduce brown or red marks, Dr. Narins suggests.

And as more products hit the market, the possibilities for combinations will only expand according to each doctor's creative abilities.

"Each one of these fillers has their niche and each has a particular area where it shines," Dr. Narins says. "In the lips, you may want an HA or silicone. And for etched-in lines on the side of the face, you may want to use Artefill (Artes Medical) or Radiesse, which are longer-lasting.

"What will be key will be for patients to make sure to go to experts so they can pick the right filler or combination of fillers that are appropriate," she says.

As with most new cosmetic surgery products, Juvederm's own unique nuances and benefits will likely come to light as dermatologists use the product over time.

"Juvederm may very well have a distinctive factor that dermatologists begin to discover after they've used it for a while," Dr. Narins says.

Disclosure: Dr. Narins is on the advisory board for Medicis and is an investigator for the company.